tNPUAS联合一次性输尿管软镜一期治疗2.5~3.0 cm非鹿角状肾结石术后发生SIRS相关危险因素分析  

Analysis of risk factors related to SIRS after treatment of 2.5-3.0cm non-staghorn kidney stones with tNPUAS combined with disposable ureteroscop

作　　者：魏海洋 时新宇 许长宝[1] 李武学[1] 杨军凯 张天贺 黄志恒 赵兴华[1] WEI Haiyang;SHI Xinyu;XU Changbao;LI Wuxue;YANG Junkai;ZHANG Tianhe;HUANG Zhiheng;ZHAO Xinghua(Department of Urology,the Second Affiliated Hospital of Zhengzhou University,Zhengzhou,450000,China)

机构地区：[1]郑州大学第二附属医院泌尿外科,郑州450000

出　　处：《临床泌尿外科杂志》2024年第4期325-330,共6页Journal of Clinical Urology

摘　　要：目的:探究前段可弯负压吸引鞘(tip-flexible negative pressure ureteral access sheath,tNPUAS)联合一次性输尿管软镜一期治疗2.5~3.0 cm非鹿角状肾结石术后发生全身炎症反应综合征(systemic inflammatory response syndrome,SIRS)的相关危险因素。方法:回顾性分析2022年1月—2023年9月在郑州大学第二附属医院泌尿外科行tNPUAS联合一次性输尿管软镜一期治疗2.5~3.0 cm非鹿角状肾结石患者的临床资料,采用单因素和多因素logistic回归分析筛选与tNPUAS联合一次性输尿管软镜一期治疗2.5~3.0 cm非鹿角状肾结石术后发生SIRS的危险因素,并绘制ROC曲线,评估预测效能。结果:纳入的205例患者中,19例(9.27%)术后发生SIRS。多因素logistic回归分析显示,术前NLR>2.50(OR=2.953,95%CI:1.006~8.669,P=0.049)、AGR<1.84(OR=0.055,95%CI:0.004~0.860,P=0.039)、结石平均CT值<956.5 HU(OR=0.995,95%CI:0.992~0.998,P<0.001)和手术时间>95.7 min(OR=1.036,95%CI:1.012~1.060,P=0.003)是术后发生SIRS的独立危险因素。结论:NLR较高、AGR较低、结石平均CT值较小和手术时间较长是tNPUAS联合一次性输尿管软镜一期治疗2.5~3.0 cm非鹿角状肾结石术后SIRS的独立危险因素。术前NLR、ARG及结石平均CT值在预测术后SIRS的发生中具有一定的价值,同时,应严格控制手术时长以降低术后SIRS的发生。Objective:To explore the risk factors in systemic inflammatory response syndrome(SIRS)after the treatment of 2.5-3.0cm non-staghorn kidney stones with tip-flexible negative pressure ureteral access sheath(tNPUAS)combined with disposable ureteroscope.Methods:The clinical data of patients with 2.5-3.0cm nonstaghorn kidney stones treated with tNPUAS combined with disposable ureteroscope in the Department of Urology,Second Affiliated Hospital of Zhengzhou University from January 2022to September 2023were retrospectively analyzed.Univariate and multivariate logistic regression analysis were used to screen the risk factors in SIRS after the treatment of 2.5-3.0cm non-staghorn kidney stones with tNPUAS combined with disposable ureteroscope,and ROC curve was plotted to evaluate the predictive efficacy.Results:A total of 205patients were included,and 19(9.27%)had SIRS after operation.Multivariate logistic regression analysis showed that preoperative NLR>2.50(OR=2.953,95%CI:1.006-8.669,P=0.049),AGR<1.84(OR=0.055,95%CI:0.004-0.860,P=0.039),the mean CT value of calculus<956.5HU(OR=0.995,95%CI:0.992-0.998,P<0.001),and the operative time>95.7min(OR=1.036,95%CI:1.012-1.060,P=0.003)were independent risk factors in postoperative SIRS.Conclusion:Higher NLR,lower AGR,smaller mean CT value and longer operation time are independent risk factors in SIRS after treatment of 2.5-3.0cm non-staghorn kidney stones with tNPUAS combined with one-stage disposable ureteroscope.Preoperative NLR,ARG and mean CT value of calculi have certain value in predicting the occurrence of postoperative SIRS.Meanwhile,the duration of operation should be strictly controlled to reduce the occurrence of postoperative SIRS.

关 键 词：前段可弯负压吸引鞘 一次性输尿管软镜 肾结石 全身炎症反应综合征 

分 类 号：R692.4[医药卫生—泌尿科学]